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Original Substack Release Date: July 20,2025

🎯 Why Listen

Prior authorization is the bureaucratic chokehold strangling American healthcare. But this episode isn’t just venting — it’s a masterclass in how the system got built, why it persists, and where leverage actually lies. From AI-driven denials to Medicare’s looming funding cliff, we break down the forces shaping care today and what physicians and patients can do about it.

 👥 Co-Hosts

• Dutch Rojas – Founder, Bliksem Health
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
• Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur

📌 Episode Overview

What happens when AI is weaponized on both sides of prior authorization? One side uses it to deny care, the other to fight back with automated letters of medical necessity. In this episode, the panel dives into:

• How insurers and employers hold the real keys to pre-auth.
• Why 66% of patients covered by self-funded plans could eliminate it tomorrow.
• The Medicare cliff — and how boomer physicians’ choices set up today’s workforce.
• Whether raising the Medicare eligibility age or tying licensure to Medicare participation are realistic fixes.
• Why restoring physician autonomy may be the only path to sustainable care.

This is a roadmap for doctors and patients alike who want to see through the illusion of “insurance as healthcare.”

💬 Notable Quotes

• “This system isn’t designed for patients. It’s not designed for physicians. It’s designed for delay, denial, and distraction.” – Dutch Rojas
• “Every week, I get calls: friends of friends who can’t get in to see a specialist for months. That’s the storm coming.” – Dan Choi, MD
• “If you took lifetime Medicare contributions and put them in an HSA, indexed to the S&P 500, every retiree would have $2 million. Are you telling me they couldn’t manage their care better than Medicare can?” – Anthony DiGiorgio, DO
• “Doctors don’t value themselves. They accept crumbs, when they’re sitting on a goldmine of skill and trust.” – Dutch Rojas
• “We’re spending billions managing the money instead of managing the medicine.” – Sanat Dixit, MD

📚  What You’ll Learn

• Why AI is now a central player in the prior auth wars.
• The real difference between self-funded and fully insured plans — and why HR may hold the key to faster approvals.
• How boomer physicians’ decisions shaped today’s lack of autonomy in medicine.
• The economic and political pressures that make Medicare access increasingly fragile.
• Practical steps doctors can take now to push back on pre-auth and reclaim time for patients.

⏱ The Episode (Timestamps)

• [00:00] Welcome & Dan Choi’s foot drop case
• [05:30] Prior auth: emergency vs elective realities

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us a text

Original Substack Release Date: Jun 18th, 2025

This week’s episode takes you inside the chaos rocking organized medicine: ACIP’s sudden purge, the AMA’s meltdown, and the war over who really speaks for America’s doctors. If you’ve ever wondered how medical “consensus” is manufactured—and who benefits—this is the episode to hear.

• Dutch Rojas – Founder, Bliksem Health
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
• Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur

RFK Jr. just dismissed the entire vaccine advisory committee (ACIP). The AMA immediately demanded a Senate investigation. Physicians across the country are furious, divided, and asking: who speaks for medicine now?

The hosts dissect:

• The politics and economics hidden inside “independent” vaccine committees
• The AMA’s emergency session and whether medical trainees really control policy
• Why doctors keep fighting each other while insurers and hospitals grow stronger
• Whether this is the turning point for physicians to stop tweeting—and start reclaiming their profession

• “Primary care doctors are getting paid less than plumbers—and somehow they’re the ones being blamed.”
• “If Medicaid were truly a safety net, why are insurers profiting like it’s Wall Street?”
• “The moment patients control the money, the system collapses—and that’s what terrifies them.”

• Why the ACIP purge matters far beyond COVID
• How the AMA House of Delegates really works (and why residents and students may wield outsized power)
• The difference between public health paternalism and authoritarianism
• Why private practice viability might be medicine’s most important battlefield

• 00:00 – Setting the stage: RFK Jr. fires ACIP
• 02:00 – What ACIP is and why it lost credibility
• 07:00 – Economics, conflicts of interest, and vaccine committees
• 12:00 – Groupthink, ideology, and dissent in medicine
• 20:00 – From COVID mandates to authoritarian overreach
• 25:00 – Inside the AMA House of Delegates emergency resolution
• 35:00 – Who really controls the AMA (students, residents, administrators?)
• 42:00 – Why physicians keep fighting themselves instead of uniting
• 48:00 – The case for saving—and reforming—the AMA
• 50:00 – A call to arms: private practice and physician-led advocacy

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us a text

Original Substack Release Date:  June 14th, 2025

🎯 Why Listen

When the New England Journal of Medicine claims that direct primary care threatens the “common good,” four practicing physicians step into the ring. This episode isn’t just a rebuttal, it’s a full-throated defense of medical freedom, patient choice, and the future of primary care. If you want to understand how Medicaid has morphed from a safety net into a subsidy machine—and why academics and policymakers are terrified of patients controlling their own dollars—this episode is essential.

Co-Hosts

• Dutch Rojas – Founder, Bliksem Health 
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
• Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur

Episode Overview

• The NEJM op-ed that sparked outrage: framing DPC as a social harm while ignoring why doctors are leaving the insurance system.
• Why direct primary care isn’t boutique medicine—it’s an economic correction to price-fixing and burnout.
• The Medicaid industrial complex: how states and managed care organizations profit while patients wait for access.
• Real numbers: Centene makes ~$18,000 per member annually, while primary care doctors earn less than plumbers.
• State-level gaming: double enrollment, lax verification, and taxpayer waste.
• A better alternative: DPC + catastrophic coverage + HSAs at less than $7,000/year.
• The hypocrisy of policy academics: designing broken payment systems, then blaming practicing physicians for opting out.

Notable Quotes

• “Primary care doctors are getting paid less than plumbers—and somehow they’re the ones being blamed.” - Dr. Dan Choi 
• “If Medicaid were truly a safety net, why are insurers profiting like it’s Wall Street?” - Dr. Dan Choi 
• “The moment patients control the money, the system collapses—and that’s what terrifies them.” - Dr. Dan Choi 

What You’ll Learn

1. Why the NEJM perspective on DPC gets the economics wrong.
2. How Medicaid expansion shifted from safety net to subsidy scheme.
3. The real cost of managed Medicaid—and who profits most.
4. Why HSAs and direct primary care offer a scalable, patient-centered alternative.
5. How academic medicine fuels policy myths that widen access gaps.

The Episode (Timestamps)

• 00:00 – Opening banter and NEJM op-ed overview
• 02:00 – The ideology behind calling primary care a “common good”
• 06:00 – Economics of primary care and why DPC emerged
• 10:00 – Medicaid’s expansion: safety net or single-payer on training wheels?
• 20:00 – State-level gaming and provider tax loopholes
• 29:00 – DPC + catastrophic plan + HSA: a viable alternative
• 38:00 – Manage

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us a text

Original Substack Release Date:  June 7th, 2025

🎯 Why Listen:

“Shut up and enjoy your salary.”

—What passes for health policy debate in 2025.

Does the government actually listen to doctors anymore? Or do they just think we’re a nuisance — good for photo ops, useless in policymaking?

In this episode of The Doctor’s Lounge, Dutch and Anthony pull no punches on Medicare:

• Why Medicare is becoming more of a political weapon than a healthcare program
• How physicians are silenced through salary-shaming, cancel tactics, and faux moral outrage
• The growing influence of private insurers in Medicare Advantage — and who really benefits
• How policy training for medical students and experts conditions them to obey the system, not challenge it

This isn’t just a rant. It’s a roadmap for resisting. If you’re a doctor, you need to hear this. If you’re a patient, you deserve to know who’s really shaping healthcare behind the curtain.

Co-Hosts:

• Dutch Rojas - Private Healthcare Advocate
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher.
• Anish Koka, MD – Private practice cardiologist, Philadelphia; healthcare policy commentator.
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice.
• Sanat Dixit, MD, FACS - Neurosurgeon - Huntsville, AL, Faculty - Vanderbilt University; healthcare entrepreneur.

Episode Overview:

Medicare covers more than 65 million Americans, but its foundation is under political, financial, and operational strain. A break down how Medicare is structured, the differences between Parts A, B, C, and D, and why Medicare Advantage is both a lifeline and a lightning rod. They connect the dots between low reimbursement rates, rising administrative control, and the silencing of physician voices in policymaking. Along the way, they expose the hypocrisy of those who dictate policy without participating in the systems they regulate — and what it will take to restore physician autonomy and patient-first care.

Notable Quotes:

• “Medicare was built on a promise — but promises need funding and accountability to work.” – Anthony DiGiorgio
• “When private insurers run Medicare Advantage, the incentives shift — and sometimes patients aren’t the winners.” – Dutch Rojas

The Episode:

00:00 – Welcome & Introduction

01:20 – What Medicare Covers and Who Qualifies

05:10 – The Funding Structure of Medicare

09:40 – Breaking Down Part A, B, C, and D

14:15 – Reimbursement Challenges in Medicare

19:25 – Medicare Advantage: Pros and Cons

24:50 – How Politics Shapes Medicare Policy

30:15 – Real-World Stories from the Field

35:00 – Potential Reforms and the Future of Medicare

39:30 – Closing Thoughts

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us a text

🎯 Why Listen:

A candid conversation on whether non-compete clauses in physician contracts harm doctors, patients, and the healthcare system — and what real reform might look like.

Co-Hosts:

• Dutch Rojas - Private Healthcare Advocate
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher.
• Anish Koka, MD – Private practice cardiologist, Philadelphia; healthcare policy commentator.
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice.
• Sanat Dixit, MD, FACS 

Episode Overview:

Dutch and Anthony tackle the controversial topic of non-compete clauses in physician contracts — exploring their history, how they affect patient access, and whether proposed bans could change the landscape for both independent and employed doctors. Along the way, they discuss the unintended consequences of eliminating non-competes, the corporate pushback against reform, and what a balanced solution might look like.

Notable Quotes:

• “When a hospital locks down a doctor with a non-compete, they’re really locking down the patients.” – Anthony DiGiorgio
• “If we want more competition in healthcare, we can’t keep building fences around physicians.” – Dutch Rojas

The Episode:

00:00 – Welcome & Introduction

01:10 – What Are Non-Competes?

03:45 – The History Behind Physician Non-Competes

07:20 – How Non-Competes Limit Patient Access

10:40 – The FTC’s Proposed Ban & Pushback

15:05 – Hospital Arguments for Keeping Non-Competes

19:15 – Potential Unintended Consequences

24:00 – Case Studies: When Non-Competes Hurt Communities

29:30 – Alternatives to Non-Competes

34:50 – What Real Reform Could Look Like

38:10 – Closing Thoughts

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us a text

Why Physicians Need a Voice in Healthcare Policy

👥 Hosted by: Dutch Rojas

Doctors:

•Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher at San Francisco General Hospital.

•Anish Koka, MD – Private practice cardiologist, Philadelphia; long-time health policy commentator.

•Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; early adopter of social media in spine surgery; healthcare advocate.

•Sanat Dixit, MD, FACS – Neurosurgeon - Huntsville, AL, Faculty - Vanderbilt University; healthcare entrepreneur.

🔍 Episode Overview:

In this roundtable kickoff episode, four outspoken physicians join Dutch Rojas in The Doctor’s Lounge to talk candidly about the intersection of medicine, policy, and politics — and why more doctors need to speak up. From certificate-of-need laws to Medicare payment reform, from the Trump administration’s appointments to RFK’s role at HHS, the conversation dives into the structural problems holding back both doctors and patients.

The doctors share why they each agreed to join the podcast, the power and pitfalls of physicians engaging publicly, and the need to protect autonomy in a system dominated by corporate healthcare and government bureaucracy.

📌 Notable Quotes:

• “If you truly want a free society, you need independent physicians.” – Dr. Dan Choi

• “Once the government became a plan operator, it invited rent-seeking — and that’s all we’ve seen since.” – Dr. Anthony DiGiorgio

• “Our patients trust us. We have to make sure the profession stays noble — and that means fixing the system.” – Dr. Sanat Dixit

• “Republicans buy sneakers too. Stick to policy if you want your message heard.” – Dr. Anish Koka

The Episode:

00:00 – Welcome to The Doctor’s Lounge

00:33 – Meet the Doctors

03:11 – Why This Podcast?

05:05 – Tuttle Twins & Shaping Culture

07:28 – Getting Physician Ideas Heard

09:30 – Certificate-of-Need Laws

10:53 – Passion for the Profession

11:55 – Structural Reforms for a New Administration

13:48 – Political Appointments & Culture Shift

16:33 – Political Practicality vs. Idealism

17:43 – Cynicism from the Lobbying Trenches

22:00 – Is Democracy Still Working in Healthcare?

23:36 – Behind the Scenes in D.C.

24:57 – RFK at HHS

30:11 – Metrics for Measuring Change

33:45 – The Medicare Problem

35:41 – The Case for Physician-Owned Hospitals

39:32 – Facility Fees & Payment Disparity

46:00 – Site-Neutral Payment Reform

50:10 – Policy vs. Politics

53:30 – Social Media & Physician Speech

59:00 – The Chilling Effect of Employment

01:02:14 – Restoring Free Speech for Physicians

01:05:00 – Advice for Physicians Considering Speaking Out

01:08:00 – Closing Thoughts

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X